Sexual Satisfaction and Relationship Status in Long-term Survivors of Human Papillomavirus-Associated Oropharyngeal Carcinoma

Abstract

To characterize the long-term relationship and sexual satisfaction in human-papillomavirus-associated oropharyngeal cancer (HPVOPC) patients following radiotherapy (RT) or chemoradiotherapy (CRT). A cross-sectional study was undertaken at a high volume head and neck center in HPV OPC survivors ≥12 months from completion of radical CRT/RT. As part of a larger study, patients completed multiple questionnaires. We report the results of: (1) a survey developed specifically addressing sexual and relationship status; (2), EORTC global (QLQ-C30) and sexual health (QLQ-SHQ22) QOL (score 0-100, higher score reflects better QOL) and (3) symptom burden (MDASI-HN; 0-10; lower scores reflect lower toxicity). Sexual satisfaction is a multi-item functional scale from the SHQ22. Forty-seven patients were enrolled. Median assessment time was 2.9y (1-5.1y) following CRT/RT. Median age was 64 (range: 50-74); 89% were male and 83% were married/de facto relationship at diagnosis. Stage I, II and III were 55%, 19%, and 26%, respectively (AJCC8). Most received 70Gy/35# (94%) and CRT (81%). The median global QOL score was 83 (IQR 67-88). The median MDASI-HN total severity score was 1.8 (IQR 0.7–3.0). The median sexual satisfaction domain score was 42 (IQR 17-68). Although most (34/46; 74%) patients reported an active sex life as important, only 24% (11/47) reported being sexually active (‘quite a bit’ or ‘very much’). The majority of patients reported low levels (‘not at all’ or ‘little bit’) of satisfaction with their sex life (28/46; 61%), of sexual enjoyment (24/45; 53%), of satisfaction with intimacy (26/44; 59%), of sexual desire (23/46; 50%), ability to reach orgasm (21/43; 49%) and enjoyment from sex (22/46; 37%). However only 29% (13/44) and 17% (8/46) of patients felt treatment or a lack of energy, respectively, affected their sexual activity (‘quite a bit’ or ‘very much’). The sexual satisfaction functional domain score was most significantly driven by the items reporting level of sexual activity and satisfaction with intimacy or their sex life. The sexual satisfaction score did not correlate with quality of life or symptom burden (all r<0.2). Our developed survey found that while 47% (18/38) reported a negative change in their sexual relationship since treatment, most patients partnered at diagnosis reported no change in their general relationship status compared to before treatment (23/40; 57%); 32% (13/40) reported a positive change; only few reported a negative effect (4/40; 10%). Although the majority of HPVOPC survivors considered an active sex life important, only a minority were sexually active. Despite a high frequency of negative change in their sexual relationship and low levels of sexual satisfaction, only a minority ascribed this to treatment and only a few reported a negative change in their overall relationship.